Anorexia Nervosa in Children

What is anorexia nervosa in children?

Anorexia nervosa is an eating
disorder. It is a form of self-starvation. Children and teens with this health problem
have a distorted body image. They think they weigh too much. This leads them to severely
restrict how much food they eat. It also leads to other behavior that stops them from
gaining weight. Anorexia nervosa is sometimes called anorexia.

There are 2 types of anorexia:

Restrictor type. Children with this
type severely limit how much food they eat. This often includes foods high in
carbohydrates and fat.

Bulimic (binging and purging) type.
Children with bulimia eat too much food (binge) and then make themselves throw up.
They may also take large amounts of laxatives or other medicines that clear out the
intestines.

What causes anorexia nervosa in a child?

Experts don’t know what causes
anorexia nervosa. It most often starts as regular dieting. But it slowly changes to
extreme and unhealthy weight loss.

Other things that may play a role
in anorexia are:

Social attitudes toward body
appearance

Family influences

Genetics

Brain chemical imbalances

Developmental issues

Children with anorexia are more
likely to come from families with a history of:

Weight problems

Physical illness

Other mental health problems, such as
depression or substance abuse

Children with anorexia often come
from families that are very rigid and critical. Parents may be intrusive and
overprotective. Children with anorexia may be dependent and emotionally immature. They
are also likely to cut themselves off from others. They may have other mental health
problems, such as an anxiety disorder.

Which children are at risk for anorexia nervosa?

Most children with anorexia are
girls. But that is changing. More boys are now getting it. The disorder was first seen
in upper-class and middle-class families. But it is now found in all socioeconomic
groups and in many ethnic and racial groups.

What are the symptoms of anorexia nervosa in a child?

Each child’s symptoms may vary. He
or she may:

Have low body weight

Fear becoming obese, even as he or she
is losing weight

Have a distorted view of his or her
body weight, size, or shape. For example, the child sees his or her own body as too
fat, even when very underweight.

Refuse to stay at the minimum normal
body weight

In girls, miss 3 menstrual periods
without some other cause

Do a lot of physical activity to help
speed up weight loss

Deny feeling hungry

Be obsessed with making food

Have strange eating behaviors

Be socially withdrawn, grouchy, moody,
or depressed

Many physical symptoms linked to
anorexia are often due to starvation and malnourishment. They may include:

Very dry skin (when pinched and let
go, it stays pinched)

Fluid loss (dehydration)

Belly pain

Constipation

Lethargy

Dizziness

Extreme tiredness (fatigue)

Sensitivity to cold temperatures

Being abnormally thin (emaciated)

Growth of fine, downy body hair
(lanugo)

Yellowing of the skin

These symptoms may seem like other
health problems. Have your child see his or her healthcare provider for a diagnosis.
Early diagnosis and treatment are vital. They can help prevent future problems.

How is anorexia nervosa diagnosed in a child?

Parents, teachers, and coaches may
be able to spot a child or teen with anorexia. But many children first keep their
illness very private and hidden.

A child psychiatrist or a mental
health expert can diagnose anorexia. He or she will talk with parents and teachers about
the child’s behavior. In some cases, your child may need mental health testing.

How is anorexia nervosa treated in a child?

Treatment will depend on your
child’s symptoms, age, and general health. It will also depend on how severe the
condition is.

Treatment often involves a mix
of:

Individual therapy

Family therapy

Behavior changes

Nutritional rehab

Antidepressant medicines, if your
child is also depressed

Anorexia is a serious condition
that causes frequent health problems. It can be severe enough that it leads to death.
Because of this, both your child’s healthcare provider and a nutritionist must be active
members of the care team. Parents play a vital role in any treatment. Your child may
need to go to the hospital for problems linked to weight loss and malnutrition.

What are possible complications of anorexia nervosa in a
child?

Anorexia and the malnutrition that
results can harm nearly every organ system in the body. It can be fatal. It may lead to
health problems with the:

Heart. Damage to the heart can happen because of
malnutrition or repeated vomiting. A child may have a slow, fast, or irregular
heartbeat. He or she may also have low blood pressure.

Blood. About 1 in 3 children with anorexia have a low red
blood cell count (mild anemia). About half of children with this health problem have
a low white blood cell count (leukopenia).

Digestive tract. Normal movement in the intestinal tract
often slows down with very restricted eating and severe weight loss. Gaining weight
and taking some medicines can help fix it.

Kidneys. Fluid loss (dehydration) from anorexia may lead
to highly concentrated urine. Your child may also make more urine. This may happen
when the kidneys’ ability to concentrate urine is impaired. Kidney changes often
return to normal when your child is back to normal weight.

Endocrine system. In girls, a lack of menstrual periods is
one of the hallmark symptoms of anorexia. It often happens before severe weight loss.
It may continue after normal weight is restored. Lower levels of growth hormones are
also sometimes found in teens with anorexia. This may explain the delayed growth
sometimes seen in children with anorexia. Normal eating habits often restore normal
growth.

Bones. Children with anorexia are at a greater risk for
broken bones. When anorexic symptoms start before peak bone formation has been
reached (most often mid to late teens), there is a greater risk for decreased bone
tissue or bone loss. Bone density is often found to be low in girls with anorexia.
They may not get enough calcium in their diet or absorb enough of it.

How can I help prevent anorexia nervosa in my child?

Experts don’t know how to prevent
anorexia. But spotting and treating it early can reduce symptoms. It can enhance your
child’s normal development. It can also improve his or her quality of life. Encouraging
your child to have healthy eating habits and realistic attitudes toward weight and diet
may also help.

How can I help my child live with anorexia nervosa?

If you are worried your child has
an eating disorder, talk with your child’s provider right away. Here are things you can
do to help your child:

Keep all appointments with your
child’s healthcare provider.

Take part in family therapy when suggested.

Have a supportive and compassionate attitude toward your child.
Get individual counselling for yourself if you are struggling.

Talk with your child’s healthcare
provider about other providers who will be included in your child’s care. Your child
may get care from a team that may include counselors, therapists, social workers,
psychologists, psychiatrists, and registered dietitian nutritionists. Your child’s
care team will depend on your child’s needs and how serious the anorexia is.

Tell others about your child’s
anorexia. Work with your child’s healthcare provider and school to create a treatment
plan.

Check on school resources for your child. Anorexia may
interfere with your child's ability to succeed in school. The Americans with
Disabilities Act (ADA) and Section 504 of the Civil Rights Act can help your child
get an appropriate education. Talk with your child’s teachers and principal to
find out about these protections.

Reach out for support from local
community services. Being in touch with other parents who have a child with an eating
disorder may be helpful.

Key points about anorexia nervosa in children

Anorexia nervosa is an eating
disorder. It is a form of self-starvation.

Many things may play a role in
anorexia, such as social attitudes toward body appearance and family influences.

A child with anorexia has low body
weight. He or she often has a distorted view of his or her body.

Physical symptoms may include very dry
skin, belly pain, and constipation.

A mental health expert can diagnose
anorexia.

Treatment may include therapy and
nutritional rehab. Family therapy may be an important part of treatment.

Next steps

Tips to help you get the most from
a visit to your child’s healthcare provider:

Know the reason for the visit and what
you want to happen.

Before your visit, write down
questions you want answered.

At the visit, write down the name of a
new diagnosis, and any new medicines, treatments, or tests. Also write down any new
instructions your provider gives you for your child.

Know why a new medicine or treatment
is prescribed and how it will help your child. Also know what the side effects
are.

Ask if your child’s condition can be
treated in other ways.

Know why a test or procedure is
recommended and what the results could mean.

Know what to expect if your child does
not take the medicine or have the test or procedure.

If your child has a follow-up
appointment, write down the date, time, and purpose for that visit.

Know how you can contact your child’s
provider after office hours. This is important if your child becomes ill and you have
questions or need advice.